January 17, 2025

A 2 month old girl is brought to the ED with poor feeding and fussiness

By Med-Challenger · 1 minute read

A 2 mo previously healthy girl is brought to the ED with poor feeding and fussiness for several hours. She has had 2 episodes of non-bloody, non-bilious emesis. On examination, she is afebrile and mildly tachypneic. She has a capillary refill time of 2 seconds and is appropriately fussy with examination.

She has HR 288, and you note the following rhythm on the monitor:

image (63)

ECG courtesy of Dr. Rebekah Burns

After your initial maneuvers have failed, which of the following is the most appropriate next step in management assuming her physical exam is unchanged?

IV adenosine
Defibrillation
Isotonic fluid bolus
Synchronized cardioversion

The correct answer is:

IV adenosine

The patient in the vignette is presenting with stable supraventricular tachycardia (SVT). After initial vagal maneuvers, such as a bag of ice slurry to the face, the most appropriate next step is administration of IV adenosine. Immediate synchronized cardioversion would be considered for unstable SVT (hypotension, altered mental status), while defibrillation is not indicated for SVT or any other situation where the patient has a pulse. Isotonic fluid bolus will not resolve the patient’s SVT, and should only be done with extreme caution as this may precipitate pulmonary edema in patients in active SVT, [Topjian 2020]

This question appears in Med-Challenger Pediatric Emergency Medicine 3rd Edition Exam Review with CME

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